Association of Active Human Herpesvirus-6, -7 and Parvovirus B19 Infection with Clinical Outcomes in Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Frequency of active human herpesvirus-6, -7 (HHV-6, HHV-7) and parvovirus B19 (B19) infection/coinfection and its association with clinical course of ME/CFS was evaluated. 108 ME/CFS patients and 90 practically healthy persons were enrolled in the study. Viral genomic sequences were detected by PCR, virus-specific antibodies and cytokine levels—by ELISA, HHV-6 variants—by restriction analysis. Active viral infection including concurrent infection was found in 64.8% (70/108) of patients and in 13.3% (12/90) of practically healthy persons. Increase in peripheral blood leukocyte DNA HHV-6 load as well as in proinflammatory cytokines' levels was detected in patients during active viral infection. Definite relationship was observed between active betaherpesvirus infection and subfebrility, lymphadenopathy and malaise after exertion, and between active B19 infection and multijoint pain. Neuropsychological disturbances were detected in all patients. The manifestation of symptoms was of more frequent occurrence in patients with concurrent infection. The high rate of active HHV-6, HHV-7 and B19 infection/coinfection with the simultaneous increase in plasma proinflammatory cytokines' level as well as the association between active viral infection and distinctive types of clinical symptoms shows necessity of simultaneous study of these viral infections for identification of possible subsets of ME/CFS. 1. Introduction Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disease characterized by profound disabling fatigue lasting at least 6 months and accompanied by a combination of nonspecific symptoms. According to the 1994 US Center’s for Disease Control and Prevention (CDC) case definition, which at present, is widespread in research and clinical practice, at least four out of eight symptoms (impaired memory or concentration, sore throat, tender cervical or axillary lymph nodes, muscle pain, multi-joint pain, new headaches, sleep disturbances and post-exertion malaise) should be present in cases of ME/CFS [1]. During the clinical course of disease multiple body systems are affected by immune, neuroendocrine, musculoskeletal as well as psychiatric factors that reflect on the heterogeneity of the disease. Because fatigue is a common symptom of many diseases, a wide differential diagnosis needs to be done. The observation that many cases of the disease begin with a flu-like illness has prompted the hypothesis that viral infections are implicated in this disorder. Infections of human -herpesviruses-human herpesvirus-6 and -7 (HHV-6, HHV-7),
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